THE A/H1N1 HOAX PANDEMIC SCARE TATICS

Canada Issues Alert on Severe Respiratory Disease in Mexico

Recombinomics Commentary 02:22
April 23, 2009


The Public Health Agency of Canada has told quarantine services to be on alert for travellers returning from Mexico after a number of severe respiratory illnesses (SRI) were reported in some regions of the country.

PHAC, in an April 20 report, said Mexican officials informed the Canadian health agency that the "case-fatality rate was relatively high" and that most cases involved healthy adults between the ages of 25 and 44. A number of health-care workers were also affected.

Although no cause has been confirmed, some samples were positive for influenza A and B.

The above comments on an alert issued by Canada offer some insight into the situation in Mexico. The reports out of Mexico are decidedly mixed. Some reports describe an increase in influenza cases which is attributed to a late spike in influenza B, which when combined with influenza A, gives an abnormally high number of cases this late in the season. Other reports discuss revaccinating at risk groups with the current trivalent vaccine.

Samples have been sent to Canada for a comprehensive analysis.

The increased influenza-like illness and fatalities was announced as the CDC issued an MMWR dispatch on H1N1 swine flu. Two cases have been confirmed in children (9F and 10M) and family members had mild symptoms but were not tested. The precise location of the clusters in southern California has not been released, but one cluster is in San Diego Country, while the other is 100 miles away in Imperial County (see updated map). Additional suspect cases in Imperial County have been noted and it is likely that these cases are near the border with Mexico. Some media reports also note that some contacts have not been interviewed because they were in Mexico.

It remains unclear if these two outbreaks are related. All reported cases in California have been mild, and the two confirmed cases were influenza A positive, but failed to sub-type for seasonal flu. It is unclear if sub-typing failures have led to the confusing reports out of Mexico.

23/Apr/09
http://www.elsemanario.com.mx/news/news_di...?story_id=19072


MEXICO CITY .- The Ministry of Health yesterday began a siege of health hospitals in the Federal District before the alert for cases of influenza.

The outbreak of respiratory disease, which claimed 13 lives in the capital, changed part of the routine of the hospital, the staff began to be vaccinated, was suspended access to pregnant women, were canceled the medical students for 15 days, restricted visits and a few family members who entered were given masks.

North Bay Parry Sound District Health Unit

News Release

********************

The North Bay Parry Sound District Health Unit advises that a number of severe respiratory illness (SRI) cases are occurring in various locations of south and central Mexico. At this time, no cases have been reported outside of Mexico. Physicians and local healthcare workers are asked to actively watch for cases of SRI, especially in people who have returned from Mexico within the last two weeks.

The people in Mexico who have SRI began with influenza-like symptoms that rapidly progressed to severe respiratory distress in about 5 days, with many requiring mechanical ventilation. Some patients have died. Most people who became ill were previously healthy young adults aged between 25-44 years old. Some health care workers have also been affected.

The Health Unit notified physicians, hospitals, and walk-in clinics within the North Bay Parry Sound catchment area. If you have visited Mexico in the last two weeks and have influenza-like symptoms (eg: fever, cough, sore throat, muscle or joint aches, shortness of breath) seek medical attention.

To stay healthy and prevent the spread of infections, the Health Unit recommends:

• Wash your hands well and often.
• Sneeze and cough into your upper sleeve.
• Stay at home when you are ill.
• Eat a well-balanced diet.

The Health Unit will provide more information as it becomes available.

Canada on alert after respiratory illnesses reported in Mexico

Canwest News ServiceApril 22, 2009
http://www.calgaryherald.com/Health/Canada...3180/story.html


OTTAWA — The Public Health Agency of Canada has told quarantine services to be on alert for travellers returning from Mexico after a number of severe respiratory illnesses (SRI) were reported in some regions of the country.

Mexican health authorities contacted PHAC last Friday to inform them of the respiratory conditions, which were reported in the south and central areas of Mexico. The cases elevated from flu-like symptoms to severe respiratory conditions in about five days, with "a high proportion" of cases requiring assisted ventilation.

PHAC, in an April 20 report, said Mexican officials informed the Canadian health agency that the "case-fatality rate was relatively high" and that most cases involved healthy adults between the ages of 25 and 44. A number of health-care workers were also affected.

Although no cause has been confirmed, some samples were positive for influenza A and B.

PHAC said the concern for Canadians travelling from Mexico serves as a "reminder of the importance of the SRI hospital-based surveillance established after the SARS outbreak in Canada."

500 cases reported in Mexico City

Thursday, April 23, 2009

The contagion has affected workers and employees of major public hospitals in the Capital, such as the Juarez Hospital, General Hospital, National Institute of Respiratory Diseases, and hospitals in the area of Tlalpan

MEXICO CITY .- At least 500 employees of the Health sector in Mexico City are infected with influenza virus, reported Antonio Sanchez Arriaga, general secretary of the National Independent Union of Health Workers.

The contagion has affected workers and employees of major public hospitals in the Capital, such as the Juarez Hospital, General Hospital, National Institute of Respiratory Diseases, and hospitals in the area of Tlalpan, where the National Institute Cardiology, the National Nutrition Institute and the Hospital Manuel Gea González, in addition to the Red Cross Polanco.

The union leader warned that the number of infections could triple this week not to take necessary health measures

"Last Friday we learned of the infection and ask our representatives in the various hospitals who send us reports of patients, and found that the focus of infection and reached 500 partners," said Sanchez Arriaga.

The leader of the guild said that the authorities are overcome by the presence of influenza in hospitals and only palliative measures have been implemented to try to prevent further infections.

"Right now we are being vaccinated and are taking a week leave to employees who are sick, but this is already an epidemic, and again we believe that if this continues this week we could have more than 500 thousand infected," he said.

Sanchez Arriaga explained that it is essential to vaccinate personnel working in the areas of neonatology, pediatrics, gynecology and pulmonology, and who have the most potential for spreading infection in high risk populations.

(Imelda Garcia / Agency Reform)

New Strain of Swine Flu Investigated

Two Children in San Diego Area Had No Contact With Pigs

By David Brown
Washington Post Staff Writer
Wednesday, April 22, 2009
http://www.washingtonpost.com/wp-dyn/conte...9042103694.html


Public health authorities are investigating two highly unusual cases of a previously unknown strain of swine flu that was found in the San Diego area late last month.

The cases occurred almost simultaneously in children who had no contact with pigs or each other, a scenario that raised the possibility that the illnesses may be the sign of an emerging pandemic strain of influenza.

More than 50 scientists and epidemiologists at the Centers for Disease Control and Prevention in Atlanta are studying the strain, and dozens of public health investigators in Southern California are looking for more cases among the those who had contact with the children.

"While we have a low index of suspicion that this is a pandemic, we're being very careful in our investigation to rule out every possibility," said Lyn Finelli, an epidemiologist in the CDC's influenza division.

Neither of the children -- a 10-year-old boy in San Diego County and a 9-year-old girl in Imperial County, just to the east -- was seriously ill. The cases were detected because both children were treated at clinics that took nose or throat swabs looking for influenza and passed the samples on to health department labs when they could not identify the strains.

"It was a very fortunate lightning strike," Finelli said yesterday.

Both children have recovered. The boy, however, took an airplane trip to Texas with his younger brother while at the tail end of his illness before it was known that he had an unusual strain of flu. Health officials in the Dallas area are looking for cases there, as well as among airline employees who assisted the two children, who traveled as "unaccompanied minors."

Public health officials in the two California counties -- both of which border Mexico -- are urging physicians and hospitals to look carefully for cases of flu and report any to local health departments.

Flu season, which officially ended this month, was mild this year. However, Stephen Munday, the health officer for Imperial County, said his jurisdiction saw cases late in March, although not enough to qualify as an outbreak. Whether any other cases involved swine flu is unknown at this point.

The Imperial County girl fell ill on March 28 with cough and a high fever, and the San Diego boy came down with similar symptoms, as well as vomiting, two days later. People in both households became sick before and after the children did, although health officials have not determined whether they also had swine flu.

Munday said his department has drawn blood from more than 20 people to be tested for antibodies to the swine flu strain. The antibodies would be a sign that those people were infected even if they never had symptoms. He said some had traveled into Mexico recently but would not describe them further.

"As of yet, we have not been able to come up with any explanation of why anyone would have swine flu," he said.

Molecular analysis of the virus suggests that it is the product of a rare event called a "gene reassortment." In a reassortment, two distinct strains of virus infect the same cell. The viruses take over the cell's genetic machinery to make copies of themselves, mingling the genes of the two strains to create a new, essentially hybrid, strain. Six of the eight genes in the new strain are from the North American lineage of swine flu, but two are from the Eurasian lineage.

The reassortment probably occurred in a pig sometime in the past decade. Both sets of genes are slightly different from those of their original lineage -- a sign that time has passed. However, it is unlikely that they have been in humans very long.

"If these viruses had been circulating at low levels in humans for several years, we probably would have detected them," said Nancy J. Cox, head of the CDC's influenza division.

The ability to find and identify rare strains of influenza virus has improved greatly in the past decade, spurred in part by the "bird flu" outbreak in Asia and the anthrax attacks of 2001.

In the past three years, the CDC has investigated 12 cases of human illness caused by swine flu strains. In 11 of the cases, however, the infected people had direct or indirect exposure to pigs.

In 1976, a strain of swine flu caused illness in 13 soldiers at Fort Dix in New Jersey, killing one.

Fearing a pandemic might be in the offing, the federal government ordered emergency production of a vaccine and made plans to administer it to millions of elderly and vulnerable Americans. Mass immunization was halted, however, when the virus did not spread and some vaccine recipients developed a rare neurological disorder called Guillain-Barre syndrome.

Swine flu cases up to 7; officials expand probe

By MIKE STOBBE – 18 minutes ago
http://www.google.com/hostednews/ap/articl...zMM_EQD97OFAI80

ATLANTA (AP) — Health officials are investigating a never-before-seen form of the flu that combines pig, bird and human viruses and which has infected seven people in California and Texas. All the victims recovered, but the cases are a growing medical mystery because it's unclear how they caught the virus.

None of the seven people were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other, according to the U.S. Centers for Disease Control and Prevention.

Still, health officials said it's not a cause for public alarm: The five in California and two in Texas have all recovered, and testing indicates some mainstream antiviral medications seem to work against the virus.

Dr. Anne Schuchat of the CDC said officials believe it can spread human-to-human, which is unusual for a swine flu virus.

The CDC is checking people who have been in contact with the seven confirmed cases, who all became ill between late March and mid-April.

Because of intensive searching, it's likely health officials will find additional cases, said Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.

CDC officials detected a virus with a unique combination of gene segments that have not been seen in people or pigs before. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia.

Health officials have seen mixes of bird, pig and human virus before, but never such an intercontinental combination with more than one pig virus in the mix.

Scientists keep a close eye on flu viruses that emerge from pigs. The animals are considered particularly susceptible to both avian and human viruses and a likely place where the kind of genetic reassortment can take place that might lead to a new form of pandemic flu, said Dr. John Treanor, an infectious disease specialist at the University of Rochester Medical Center.

The virus may be something completely new, or it may have been around for a while but was only detected now because of improved lab testing and disease surveillance, CDC officials said.

The virus was first detected in two children in southern California — a 10-year-old boy in San Diego County and a 9-year-old girl in neighboring Imperial County.

The cases were detected under unusual circumstances. One was seen at a Navy clinic that participates in a specialized disease detection network, and the other was caught through a specialized surveillance system set up in border communities, CDC officials said.

On Thursday, investigators said they had discovered five more cases. That includes a father and his teenage daughter in San Diego County, a 41-year-old woman in Imperial County (the only person hospitalized), and two 16-year-old boys who are friends and live in Guadalupe County, Texas, near San Antonio.

The Texas cases are especially puzzling. One of the California cases — the 10-year-old boy — traveled to Texas early this month, but that was to Dallas, about 270 miles northeast of San Antonio. He did not travel to the San Antonio area, Schuchat said.

The two 16-year-olds had not traveled recently, Texas health officials said.

The swine flu's symptoms are like those of the regular flu, mostly involving fever, cough and sore throat, though some of the seven also experienced vomiting and diarrhea.

CDC are not calling it an outbreak, a term that suggests ongoing illnesses. It's not known if anyone is getting sick from the virus right now, CDC officials said.

It's also not known if the seasonal flu vaccine that Americans got last fall and early this year protects against this type of virus. People should wash their hands and take other customary precautions, CDC officials said.

U.S. health officials are consulting with Mexican and Canadian health officials, and the CDC is beginning to receive samples from Mexico for testing, a CDC spokesman said. The ethnicity of the seven confirmed cases was not disclosed.

CDC confirms 7 cases of swine flu in humans

23 APR 2009
By Elizabeth Landau
http://www.cnn.com/2009/HEALTH/04/23/swine...ref=mpstoryview


(CNN) -- A total of seven cases of a previously undetected strain of swine flu have been confirmed in humans in the United States, the Centers for Disease Control and Prevention said. None of the patients has had direct contact with pigs.

Five of the cases have been found in California, and two have been found in Texas, near San Antonio, said Dr. Anne Schuchat, the CDC's Interim Deputy Director for Science and Public Health Program.

The CDC reported Tuesday that two children in the San Diego, California, area, infected with a virus called swine influenza A H1N1, whose combination of genes has not been seen in flu viruses in either human or pigs before.

The patients range from age 9 to 54, Schuchat said. They include two 16-year-old boys who attend the same Texas school, and a father and daughter in California.

"The good news is that all seven of these patients have recovered," Schuchat said.

The first two cases were picked up through a special influenza monitoring program, with stations in San Diego and El Paso, Texas. The program aims to get a better sense of what strains exist and to detect new strains before they become widespread, the CDC said. Other cases emerged through routine and expanded surveillance.

At this point, the ability for the human influenza vaccine to protect against this new swine flu strain is unknown, and studies are ongoing, she said.

There is no danger from contracting the virus from eating pork products, Schuchat said.

The new virus has genes from North American swine and avian influenza, human influenza and swine influenza normally found in Asia and Europe, said Nancy Cox, chief of the CDC's Influenza Division.

Swine flu is a respiratory disease of pigs caused by type A influenza, according to the CDC. It does not normally inflect humans, but cases have occurred among people, especially those who have had direct exposure to pigs. There have also been cases in the past of one person spreading swine flu to other people, the CDC said.

In 1988, in an apparent swine flu infection in pigs in Wisconsin, there was antibody evidence of virus transmission from the patient to health care workers who had contact with the patient, the CDC said.

Person-to-person transmission is believed to occur in a manner similar to the spread of the influenza virus: through infected people coughing and sneezing, the CDC said. People may contract swine flu by touching something with viruses on it and then touching their mouth or nose.

From December 2005 to February 2009, 12 cases of human infection with swine flu were documented.

Symptoms of swine flu in humans are expected to resemble regular human seasonal influenza symptoms, including fever, lethargy, lack of appetite, and coughing, the CDC said. Other reported symptoms include runny nose, sore throat, nausea, vomiting and diarrhea.

The new strain of swine flu has been resistant to the antiviral drugs amantadine and rimantadine, but has responded to the other licensed options: oseltamivir and zanamivir.

The CDC is working closely with health officials in California and Texas to learn more about the virus. The agency expects to find more cases, Schuchat said.

If swine flu can mutate to spread between humans, what does this mean for avian flu? Because of the virus subtype, it is less likely that avian flu would become transmissible from person to person, but still possible, said Dr. William Short at the division of infectious diseases at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania.

The news is not cause for widespread panic, but people at risk -- those who live in or have traveled to the areas where patients live, or have been in contact with pigs -- should watch out for symptoms and get tested if they occur, Short said.

The three criteria for a pandemic are a new virus to which everybody is susceptible, the ability to spread from person to person readily, and wide geographic spread, said Dr. Jay Steinberg, infectious disease specialist at Emory University Hospital Midtown in Atlanta, Georgia. The new strain of swine flu only meets one of these criteria: its novelty.

On the other hand, bird flu meets two of the criteria: novelty and geographic spread.

If history is any indication, flu pandemics tend to occur once every 20 years or so, meaning we're actually due for one, he said. However, it is not likely to be the swine flu, he said.

"I can say with 100 percent confidence that a pandemic of a new flu strain will spread in humans," Steinberg said. "What I can't say is when it will occur."

Swine flu cases put Nevada health officials on alert

By Mary Manning
Thu, Apr 23, 2009 (2:37 p.m.)
Beyond the Sun
http://www.lasvegassun.com/news/2009/apr/2...fficials-alert/


Nevada state health officials are on heightened alert after a federal agency confirmed seven cases of swine flu in people who appear to have had no contact with pigs.

A 10-year-old boy and a 9-year-old girl in Southern California were first diagnosed with an "unusual" strain of swine flu last week, the Centers for Disease Control and Prevention, based in Atlanta, said during a teleconference today.

Since then five other cases, including two in Texas that were confirmed this morning, have been found, officials said.

Typically, the swine flu virus was transmitted to people who had contact with pigs, but in the latest cases, no such connection to the animals has been discovered, officials said.

Although there have been no swine flu cases reported in Nevada, the state Health Division is preparing a technical bulletin for doctors around the state, Martha Framsted, spokeswoman for the health division, said.

State health investigators with epidemiologists are staying in contact with the CDC daily, said Framsted.

The technical bulletin will be posted to the state Health Division's Web site probably as soon as Friday, Framsted said.

Like typical influenza, swine flu can be prevented by washing hands thoroughly, staying home if coughing, sneezing or diarrhea is occurring and by receiving a flu vaccine annually, Framsted said.

Four different segments of influenza strains have been found in the cases of swine flu discovered so far, including the North American, the North American avian, human and swine strains from Asia and Europe, CDC officials said.

These swine flu strains combined have not been seen before in any laboratory.

A total of five swine flu cases have been confirmed in California from San Diego County and the Imperial Valley, CDC officials said. A father and his daughter contracted the flu there.

In Texas two 16-year-old boys, classmates in San Antonio, were diagnosed with the same strain.

Ages of the people who have had this swine flu range from 9 years of age to 54, CDC said. It is unknown how the virus is spreading, as a 10-year-old boy traveled from California to Dallas, but none of that particular flu strain has been found in Dallas, CDC said.

All of the cases have recovered. One was hospitalized, but has since recovered.

As the typical influenza season winds down, CDC officials said, it is unusual for swine flu to arise.

New Flu Strain Alarms Health Authorities To Possibility of Pandemic

By Christopher HIllenbrand
April 22nd, 2009 13:15 EST
http://thesop.org/index.php?article=15955


According to officials for the U.S. Centers for Disease Control, two children in California were diagnosed with a new form of the swine flu last week. And though the two children were quickly treated and both have recovered, officials are on the lookout for any more cases to arise.

The strain in question belongs to the subtype of the influenza virus known as H1N1, the same subtype responsible for the seasonal infection currently affecting some in the country. But as representatives for the C.D.C. and Prevention briefed, the new strain found in California genetically resembles a type of the virus discovered in pigs and not those infecting humans.

Health officials believe it isn`t beyond the realm of possibility that the children contracted the disease from other people and not by pigs as the strain may indicate. They said that they conferred with authorities in Canada, Mexico, and those at the World Health Organization. There have not been any more cases reported in the United States.

The C.D.C. requested doctors in the San Diego metro area, including the Imperial counties that border on Mexico, to take samples from any patients displaying flu-like symptoms.

Dr. Lyn Finelli of the C.D.C. spoke to reporters over the phone about the two cases citing "both of these kids came to our attention because they were seen in clinics which do routine surveillance for influenza infections."

The doctor assured media spokespeople that both children, a 10-year-old boy and a 9-year-old girl, did not suffer from particularly serious symptoms even though the girl experienced a fever reaching 104 degrees while she was still being treated.

Finelli said: "We are not making the assumption that there are widespread infections out there and there is not any action that the public should take right now."

The C.D.C. claimed to have never seen anything like it before.

In the last two years, 12 verified cases of infection due to a strain of the swine flu had been reported to the C.D.C., but 11 of whom were individuals that had come in contact with pigs.

The C.D.C. concluded in their statement: "Neither child had known contact with pigs. The source of infection is unknown. The lack of known exposure to pigs in the two cases increases the possibility that human-to-human transmission of this new influenza virus had occurred."

Currently, the U.S. Centers for Disease Control are investigating the people the children knew and regularly encountered, and blood testing everyone who claimed to have been ill recently.

The symptoms of the virus are normally tempered and the illness is treatable in most circumstances, although deaths attributed to the virus range from 250,000 to 500,000 in any given year. Health officials around the world worry about the chances of another strain emerging that is entirely immune to antibiotic treatment, causing a pandemic much like the 1968-1969 influenza pandemic that claimed close to 34,000 people. Almost a century ago, the world was engrossed in the worst reported influenze pandemic. Known as the "Spanish flu", this influenza strain, which has since mutated, gripped the world from 1918-1919 and killed between 30 to 100 million people worldwide in the years that followed.

Experts on the virus warn that a pandemic might be right around the corner and that global health community is stepping up efforts to effectively monitor the progress of strains known to be in existence. Authorities are scared the H5N1 avian flu virus, only present in certain birds native to Asia, Europe, Africa, and the Middle East, may mutate into a deadlier form which could lead to a pandemic.

In its present state, the H5N1 avian flu virus generally doesn`t infect people. And while cases in humans are considered rare, the World Health Organization reported that 257 of the 420 known to have been infected have died from the sickness since 2003.

Swine influenza A (H1N1) infection in 2 children - southern California,
March/April 2009
----------------------------------------------------------​------------
On 17 Apr 2009, CDC determined that 2 cases of febrile respiratory illness
occurring in children who resided in adjacent counties in southern
California were caused by infection with a swine influenza A (H1N1) virus.
The viruses from the 2 cases are closely related genetically, resistant to
amantadine and rimantadine, and contain a unique combination of gene
segments that previously has not been reported among swine or human
influenza viruses in the United States or elsewhere. Neither child had
contact with pigs; the source of the infection is unknown. Investigations
to identify the source of infection and to determine whether additional
persons have been ill from infection with similar swine influenza viruses
are ongoing. This report briefly describes the 2 cases and the
investigations currently under way. Although this is not a new subtype of
influenza A in humans, concern exists that this new strain of swine
influenza A (H1N1) is substantially different from human influenza A (H1N1)
viruses, that a large proportion of the population might be susceptible to
infection, and that the seasonal influenza vaccine H1N1 strain might not
provide protection. The lack of known exposure to pigs in the 2 cases
increases the possibility that human-to-human transmission of this new
influenza virus has occurred. Clinicians should consider animal as well as
seasonal influenza virus infections in their differential diagnosis of
patients who have febrile respiratory illness and who 1) live in San Diego
and Imperial counties or 2) traveled to these counties or were in contact
with ill persons from these counties in the 7 days preceding their illness
onset, or 3) had recent exposure to pigs. Clinicians who suspect swine
influenza virus infections in a patient should obtain a respiratory
specimen and contact their state or local health department to facilitate
testing at a state public health laboratory.

Case reports
------------
Patient A. On 13 Apr 2009, CDC was notified of a case of respiratory
illness in a boy aged 10 years who lives in San Diego County, California.
The patient had onset of fever, cough, and vomiting on 30 Mar 2009. He was
taken to an outpatient clinic, and a nasopharyngeal swab was collected for
testing as part of a clinical study. The boy received symptomatic
treatment, and all his symptoms resolved uneventfully within approximately
one week. The child had not received influenza vaccine during this
influenza season. Initial testing at the clinic using an investigational
diagnostic device identified an influenza A virus, but the test was
negative for human influenza subtypes H1N1, H3N2, and H5N1. The San Diego
County Health Department was notified, and per protocol, the specimen was
sent for further confirmatory testing to reference laboratories, where the
sample was verified to be an unsubtypable influenza A strain. On 14 Apr
2009, CDC received clinical specimens and determined that the virus was
swine influenza A (H1N1). The boy and his family reported that the child
had had no exposure to pigs. Investigation of potential animal exposures
among the boy's contacts is continuing. The patient's mother had
respiratory symptoms without fever in the 1st few days of April 2009, and a
brother aged 8 years had a respiratory illness 2 weeks before illness onset
in the patient and had a 2nd illness with cough, fever, and rhinorrhea on
11 Apr 2009. However, no respiratory specimens were collected from either
the mother or brother during their acute illnesses. Public health officials
are conducting case and contact investigations to determine whether illness
has occurred among other relatives and contacts in California, and during
the family's travel to Texas on 3 Apr 2009.

Patient B. CDC received an influenza specimen on 17 Apr 2009, which had
been forwarded as an unsubtypable influenza A virus from the Naval Health
Research Center in San Diego, California. CDC identified this specimen as a
swine influenza A (H1N1) virus on 17 Apr 2009, and notified the California
Department of Public Health. The source of the specimen, patient B, is a
girl aged 9 years who resides in Imperial County, California, adjacent to
San Diego County. On 28 Mar 2009, she had onset of cough and fever (104.3
deg F [40.2 deg C]). She was taken to an outpatient facility that was
participating in an influenza surveillance project, treated with
amoxicillin/clavulanate potassium and an antihistamine, and has since
recovered uneventfully. The child had not received influenza vaccine during
this influenza season. The patient and her parents reported no exposure to
pigs, although the girl did attend an agricultural fair where pigs were
exhibited approximately 4 weeks before illness onset. She reported that she
did not see pigs at the fair and went only to the amusement section of the
fair. The Imperial County Public Health Department and the California
Department of Public Health are now conducting an investigation to
determine possible sources of infection and to identify any additional
human cases. The patient's brother aged 13 years had influenza-like
symptoms on 1 Apr 2009, and a male cousin aged 13 years living in the home
had influenza-like symptoms on 25 Mar 2009, 3 days before onset of the
patient's symptoms. The brother and cousin were not tested for influenza at
the time of their illnesses.

Epidemiologic and laboratory investigations
-------------------------------------------
As of 21 Apr 2009, no epidemiologic link between patients A and B had been
identified, and no additional cases of infection with the identified strain
of swine influenza A (H1N1) had been identified. Surveillance data from
Imperial and San Diego counties, and from California overall, showed
declining influenza activity at the time of the 2 patients' illnesses. Case
and contact investigations by the county and state departments of health in
California and Texas are ongoing. Enhanced surveillance for possible
additional cases is being implemented in the area.

Preliminary genetic characterization of the influenza viruses has
identified them as swine influenza A (H1N1) viruses. The viruses are
similar to each other, and the majority of their genes, including the
hemagglutinin (HA) gene, are similar to those of swine influenza viruses
that have circulated among US pigs since approximately 1999; however, 2
genes coding for the neuraminidase (NA) and matrix (M) proteins are similar
to corresponding genes of swine influenza viruses of the Eurasian lineage
(1). This particular genetic combination of swine influenza virus segments
has not been recognized previously among swine or human isolates in the
United States, or elsewhere based on analyses of influenza genomic
sequences available on GenBank. Viruses with this combination of genes are
not known to be circulating among swine in the United States; however, no
formal national surveillance system exists to determine what viruses are
prevalent in the US swine population. Recent collaboration between the US
Department of Agriculture and CDC has led to development of a pilot swine
influenza virus surveillance program to better understand the epidemiology
and ecology of swine influenza virus infections in swine and humans.

The viruses in these 2 patients demonstrate antiviral resistance to
amantadine and rimantadine, and testing to determine susceptibility to the
neuraminidase inhibitor drugs oseltamivir and zanamivir is under way.
Because these viruses carry a unique combination of genes, no information
currently is available regarding the efficiency of transmission in swine or
in humans. Investigations to understand transmission of this virus are ongoing.

[Reported by: M Ginsberg, MD, J Hopkins, MPH, A Maroufi, MPH, G Dunne, DVM,
DR Sunega, J Giessick, P McVay, MD, San Diego County Health and Human Svcs;
K Lopez, MD, P Kriner, MPH, K Lopez, S Munday, MD, Imperial County Public
Health Dept; K Harriman, PhD, B Sun, DVM, G Chavez, MD, D Hatch, MD, R
Schechter, MD, D Vugia, MD, J Louie, MD, California Dept of Public Health.
W Chung, MD, Dallas County Health and Human Svcs; N Pascoe, S Penfield, MD,
J Zoretic, MD, V Fonseca, MD, Texas Dept of State Health Svcs. P Blair,
PhD, D Faix, PhD, Naval Health Research Center; J Tueller, MD, Navy Medical
Center, San Diego, California. T Gomez, DVM, Animal and Plant Health
Inspection Svc, US Dept of Agriculture. F Averhoff, MD, F Alavrado-Ramy,
MD, S Waterman, MD, J Neatherlin, MPH, Div of Global Migration and
Quarantine; L Finelli, DrPH, S Jain, MD, L Brammer, MPH, J Bresee, MD, C
Bridges, MD, S Doshi, MD, R Donis, PhD, R Garten, PhD, J Katz, PhD, S
Klimov, PhD, D Jernigan, MD, S Lindstrom, PhD, B Shu, MD, T Uyeki, MD, X
Xu, MD, N Cox, PhD, Influenza Div, National Center for Infectious and
Respiratory Diseases, CDC.]

MMWR editorial note
-------------------
In the past, CDC has received reports of approximately one human swine
influenza virus infection every 1-2 years in the United States (2,3).
However, during December 2005-January 2009, 12 cases of human infection
with swine influenza were reported; 5 of these 12 cases occurred in
patients who had direct exposure to pigs, 6 in patients reported being near
pigs, and the exposure in one case was unknown (1,4,5). In the United
States, novel influenza A virus infections in humans, including swine
influenza infections, have been nationally notifiable conditions since
2007. The recent increased reporting might be, in part, a result of
increased influenza testing capabilities in public health laboratories, but
genetic changes in swine influenza viruses and other factors also might be
a factor (1,4,5). Although the vast majority of human infections with
animal influenza viruses do not result in human-to-human transmission
(2,3), each case should be fully investigated to be certain that such
viruses are not spreading among humans and to limit further exposure of
humans to infected animals, if infected animals are identified. Such
investigations should include close collaboration between state and local
public health officials with animal health officials.

The lack of known exposure to pigs in the 2 cases described in this report
increases the possibility that human-to-human transmission of this new
influenza virus has occurred. Clinicians should consider animal as well as
seasonal influenza virus infections in the differential diagnosis of
patients with febrile respiratory illness who live in San Diego and
Imperial counties or have traveled to these areas or been in contact with
ill persons from these areas in the 7 days before their illness onset. In
addition, clinicians should consider animal influenza infections among
persons with febrile respiratory illness who have been near pigs, such as
attending fairs or other places where pigs might be displayed. Clinicians
who suspect swine influenza virus infections in humans should obtain a
nasopharyngeal swab from the patient, place the swab in a viral transport
medium, and contact their state or local health department to facilitate
transport and timely diagnosis at a state public health laboratory. CDC
requests that state public health laboratories send all influenza A
specimens that cannot be subtyped to the CDC, Influenza Division, Virus
Surveillance and Diagnostics Branch Laboratory

Transmission of Swine H1N1 in Southern California

Recombinomics Commentary 04:10
April 22, 2009

"This virus is different, very different from that circulating in pigs. That was a red flag," Finelli told WebMD and several other news organizations. "The other red flag is both cases appeared almost simultaneously, 100 miles apart.

The above comments leave little doubt that the H1N1 swine flu is being efficiently transmitted human to human in southern California. The unique constellation of swine genes has not been reported previously and the two cases do not have swine contacts. Moreover, family members had symptoms before and after the confirmed cases, indicating the H1N1 spread efficiently within each family.

However, none of the family members were tested because the H1N1 was mild and they recovered without treatment. The two cases were identified through routine surveillance, but such identifications require sero-typing. The swine sequences will test positive fro influenza A.

Therefore the virus can silently spread, which resulted in two independent detections 100 miles apart - see map for general locations. Specific locations within San Diego and Imperial countries have not been released, but upcoming testing of classmates should lead to the identification of location(s).

Although both cases recovered without hospitalization, the spread of the swine H1N1 in a human population is cause for concern. The virus can adapt and spread more efficiently. Moreover, co-infection of H1N1 swine flu and osletamivir resistant H1N1 season flu can lead to acquisition of H274Y by the swine flu via recombination or reassortment. Swine H1N1 with human H1 and N1 have been reported. Moreover, the swine flu can also infect swine and acquire more polymorphisms that could lead to increased virulence.

The 1918 pandemic strain has polymorphism from swine and human H1N1 in all eight gene segments. Similar swapping of polymorphism in human co-infected with season and swine H1N1 can lead to rapid evolution. Therefore, release of both sets of sequences, as well as new sequences, which will likely be detected in the near term in the United States and Mexico, would be useful

Update on Recent Swine Flu Cases in San Diego County

http://www.youtube.com/watch?v=BzYQWXvueC8